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We use SevenOaks Capital Associates LLC
45 Dyke Thomas, Texarkana, TX 755011
903-280-7878 fax 207-561-6498 cell 903-701-5788
What we offer Carriers and Owner Operators
1. Cost Plus Fuel Card
2. Checks mailed in 21 days
3. 3 day quick pay
4. Permit service
5. Load planning (pre-plan return load finding service)
6. Truck and Fleet Management
7. Government Freight
8. Trip Planning
9. EFS Fleet services
10. Insurance discounts (group rates)
11. Submit paperwork via Fax, eMail, or Smart Phone
12. Direct Deposit or EFS express code
13. 40% Fuel Advance once pickup is confirmed
14. Free secure eMail address
15. Free Website and hosting.
16. Sams club membership for drivers that haul 2 or more loads per year.
LET URTRUCKBROKER BE YOUR BROKER OF CHOICE!
2
To complete this application download and save to your desktop then open with Adobe
URTRUCKBROKER BROKER ID
URTRUCKBROKER US DOT 2248692 ICC MC 744384
Carrier Agreement
Representative Initial:
and survey must be completed
and returned.
Carrier:
To: Fax:
Subject: Transportation Contract
From: CONTRACT DEPT.
-
CONTRACT INSTRUCTIONS:
Complete this contract and return before hauling for UrTruckBroker.
Use blue or black ink only and initial or sign ALL pages.
Page 13 must be signed by an Officer of the company
You will receive confirmation once your payment options have been set up.
Fax all pages back to us at 1-207-561-6498.
Include:
Copy of Authority
W-9
Copy of Insurance listing UrTruckBroker as certificate holder
(we must have proof that you have no exclusions in your cargo policy for Tire, Copper, or Electronics.)
UrTruckBroker
45 Dyke Thomas
Texarkana, Tx 75501
Fill out Carrier Profile.
Any changes you make to your contract will delay processing.
UrTruckBroker will execute your signed contract and fax or mail our signature copy back to you.
CARRIER IDAGENT:
URTRUCKBROKER CORP
URTRUCKBROKER CORP
UrTruckBroker Corp
No changes to the contract terms are permitted without permission
or eMail to [email protected]
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Use Black or Blue ink only if filling out by hand, Initial each section of agreement and Sign
The ACH form is mandatory, if you factor fill it out with their ACH information, no load dispatched until complete.
Copy of insurance listing UrTruckBroker Corp as certificate holder, Request for insurance verification form mustbe filled out completely.
Carrier eMail:
Carrier ID Agent
Carrier Name: Carrier Street:
Carrier Phone: Carrier City:
Carrier Fax: Carrier State:
Carrier eMail:
Carrier Zip:
Carrier Title: Day: Month: Year;20
Title:
Carrier Contact: Carrier Insurance Agent
Carrier Insurance: Insurance Phone;
Insurance Fax: Carrier Tax ID:
Carrier Physical: Carrier Physical City:
Carrier Physical State; Zip: 800 Number:
SCAC Code: FAST Code: CSA Code IAC Number IAC Date
DBA Name: Minority Certification:
Mimority Cert NumCarrier Website:
Remit To: Bank Account Name
Carrier ABA Carrier Acc #
Carrier Bank Name:
Quick Pay: Standard Pay: Factoring: ACH: EFS
DOT: MC:
Business Type: Sole Proprietor Partnership LLC Corporation
Woman Owned Yes NO Veteran Owned Yes NO
Disabled Vet Yes NO Minority Owner Yes NO
Certified National Minority Supplier Dev Grp Yes NO
Asian Pacific American Asian Indian American Native American Indian
Hispanic American African American Other (specify)
Mailing
Carrier After Hours:
EIN SSN
MC State ID
S Corp
Trust
Other Tax
Direct Deposit Info is Mandatory
Remit to Account nameRouting Nu
Account Nu
Bank NameCarrier or Factor Company
Don't have an eMail address? Get a Free-Secure eMail Account at Truckmail.us
Factoring? Please fill in their Direct Deposit information so they can get paid on time.
Factor Name
CARRIER PROFILE Date Submitted: _____________
QUALTP-Carrier Profile-US Revised: 06/15/10 Page 4
FID (EIN) / SSN US DOT MC / State Permit
Company Name
Owner Name
Physical Address
Mailing Address
Remit Payment
Toll Free Contact Name
Local Contact Title
Fax Emergency #
Operations Email
Website Address
Operations & Service Areas Please indicate with a checkmark ( ) all that apply. All 48 States Canada Mexico Only Intrastate Hauling
Coil Racks Container Locks Liftgate FAST Code:
Ramps Sidekits Tarps CSA Code:
Satellite Enabled Teams UPS Carrier SCAC Code:
Trailer Spotting Power Only Svcs
Number of Power Units Exempt Carrier
For future reference, call this number to communicate changes in your equipment types and service areas: 800-454-6929
Equipment Types Special Services Certifications Please indicate Qty Length Axles VAN ______ ______ ______
LOGISTICS VAN ______ ______ ______
REEFER ______ ______ ______
CONTAINER ______ ______ ______
FLAT ______ ______ ______
STEPDECK ______ ______ ______
DOUBLEDROP ______ ______ ______
LOWBOY (# of Axles) ______ ______ ______
STRAIGHT TRUCK ______ ______ ______
CUBE TRUCK ______ ______ ______
CARGO VAN ______ ______ ______
TANKER ______ ______ ______
DUMP ______ ______ ______
Rail Drayage HAZMAT Certified Yes No
Port Drayage ACE Enabled Yes No
LTL (tariff-based) C-TPAT Member Yes No
Expedited Ground TWIC Cardholder Yes No
Air Freight Cartage TSA Registered Yes No Other: IAC Number:
IAC Expire Date: List Codes of Airports / Ports Serviced:
How did you hear about us? From a Landstar Agent From the Internet Networking/Word of Mouth Is your company a SmartWay Transport Partner? Yes No, If not visit: www.epa.gov/smartway
903-280-7878
Carrier ID:
List special services or areas of service:
City ST Zip
City ST Zip